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Assessment of autonomic tonus and reflexes in patients after myocardial infarction

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Myocardial Ischemia and Arrhythmia

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Summary

Two clinically applicable methods of autonomic testing have been developed, analysis of heart rate variability and baroreflex sensitivity. Most commonly, heart rate variability is assessed from 24-h Holter recordings obtained in patients 1 to 3 weeks after myocardial infarction. Several studies have demonstrated that depressed heart rate variability is associated with an increased all-cause mortality in this patient population. However, most of these studies were retrospective in nature, and relatively low values of positive predictive accuracy have been observed for this method. Moreover, there is no generally agreed method of heart rate variability analysis among different investigators.

Baroreflex sensitivity has been evaluated in at least one prospectively designed trial and has been shown to yield prognostic information in survivors of acute myocardial infarction. Most investigators utilize the phenylephrine method to assess baroreflex sensitivity. The direct comparison between both methods of autonomic testing has demonstrated that the results of one do not predict results of the other. Thus, both tests are not redundant but complementary with heart rate variability assessing tonic vagal activity whereas baroreflex sensitivity explores vagal reflexes. In an ongoing international multicenter trial (ATRAMI, Autonomic Tonus and Reflexes After Myocardial Infarction), the value of heart rate variability and baroreflex sensitivity is examined with respect to risk stratification after myocardial infarction. In this study, autonomic testing is compared to assessment of traditional risk variables such as left ventricular ejection fraction, spontaneous ectopic activity, or late potentials in the signalaverged ECG. It is expected that ATRAMI will clarify the role of autonomic testing in postinfarction risk stratification which might ultimately lead to differential therapeutic strategies based on these procedures.

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Author information

Authors and Affiliations

  1. Dept. of Cardiology, University Hospital Freiburg, Freiburg, Germany

    T. Klingenheben

  2. Dept. of Cardiology, University Hospital, Hugstetterstr. 55, D-79106, Freiburg, Germany

    Stefan H. Hohnloser M.D., F.A.C.C.

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  1. Stefan H. Hohnloser M.D., F.A.C.C.
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  2. T. Klingenheben
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Editors and Affiliations

  1. Abt. Innere Medizin III, Medizinische Universitätsklinik, Hugstetter Straße 55, 79106, Freiburg, Germany

    M. Zehender  & H. Just  & 

  2. Innere Medizin, Universitätskrankenhaus Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    T. Meinertz

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© 1994 Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt

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Hohnloser, S.H., Klingenheben, T. (1994). Assessment of autonomic tonus and reflexes in patients after myocardial infarction. In: Zehender, M., Meinertz, T., Just, H. (eds) Myocardial Ischemia and Arrhythmia. Steinkopff. https://doi.org/10.1007/978-3-642-72505-0_17

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  • DOI: https://doi.org/10.1007/978-3-642-72505-0_17

  • Publisher Name: Steinkopff

  • Print ISBN: 978-3-642-72507-4

  • Online ISBN: 978-3-642-72505-0

  • eBook Packages: Springer Book Archive

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